TY - JOUR
T1 - Pre-arrest and intra-arrest prognostic factors associated with survival following traumatic out-of-hospital cardiac arrest – A systematic review and meta-analysis
AU - Tran, Alexandre
AU - Fernando, Shannon M.
AU - Rochwerg, Bram
AU - Vaillancourt, Christian
AU - Inaba, Kenji
AU - Kyeremanteng, Kwadwo
AU - Nolan, Jerry P.
AU - McCredie, Victoria A.
AU - Petrosoniak, Andrew
AU - Hicks, Christopher
AU - Haut, Elliott R.
AU - Perry, Jeffrey J.
N1 - Funding Information:
Dr. Haut is primary investigator of contracts (CE-12-11-4489 and DI-1603-34596) and co-investigator (PCS-1511-32745) from The Patient-Centered Outcomes Research Institute (PCORI). Dr. Haut is primary investigator of a grant from the Agency for Healthcare Research and Quality (AHRQ) (1R01HS024547). Dr. Haut receives research grant support from the DOD/Army Medical Research Acquisition Activity and the Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF). Dr. Haut receives royalties from Lippincott, Williams, Wilkins for a book – “Avoiding Common ICU Errors” and is a paid consultant to Vizient. Dr. Haut was the paid author of a paper commissioned by the National Academies of Medicine.”
Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2020/8
Y1 - 2020/8
N2 - Aim: To summarize the prognostic associations of pre- and intra-arrest factors with return of spontaneous circulation (ROSC) and survival (in-hospital or 30 days) after traumatic out-of-hospital cardiac arrest. Methods: We conducted this review in accordance with the PRISMA and CHARMS guidelines. We searched Medline, Pubmed, Embase, Scopus, Web of Science and the Cochrane Database of Systematic Reviews from inception through December 1st, 2019. We included English language studies evaluating pre- and intra-arrest prognostic factors following penetrating or blunt traumatic OHCA. Risk of bias was assessed using the QUIPS tool. We pooled unadjusted odds ratios using random-effects models and presented adjusted odds ratios with 95% confidence intervals. We used the GRADE method to describe certainty. Results: We included 53 studies involving 37,528 patients. The most important predictors of survival were presence of cardiac motion on ultrasound (odds ratio 33.91, 1.87–613.42, low certainty) or a shockable initial cardiac rhythm (odds ratio 7.29, 5.09–10.44, moderate certainty), based on pooled unadjusted analyses. Importantly, mechanism of injury was not associated with either ROSC (odds ratio 0.97, 0.51–1.85, very low certainty) or survival (odds ratio 1.40, 0.79–2.48, very low certainty). Conclusion: This review provides very low to moderate certainty evidence that pre- and intra-arrest prognostic factors following penetrating or blunt traumatic OHCA predict ROSC and survival. This evidence is primarily based on unadjusted data. Further well-designed studies with larger cohorts are warranted to test the adjusted prognostic ability of pre- and intra-arrest factors and guide therapeutic decision-making.
AB - Aim: To summarize the prognostic associations of pre- and intra-arrest factors with return of spontaneous circulation (ROSC) and survival (in-hospital or 30 days) after traumatic out-of-hospital cardiac arrest. Methods: We conducted this review in accordance with the PRISMA and CHARMS guidelines. We searched Medline, Pubmed, Embase, Scopus, Web of Science and the Cochrane Database of Systematic Reviews from inception through December 1st, 2019. We included English language studies evaluating pre- and intra-arrest prognostic factors following penetrating or blunt traumatic OHCA. Risk of bias was assessed using the QUIPS tool. We pooled unadjusted odds ratios using random-effects models and presented adjusted odds ratios with 95% confidence intervals. We used the GRADE method to describe certainty. Results: We included 53 studies involving 37,528 patients. The most important predictors of survival were presence of cardiac motion on ultrasound (odds ratio 33.91, 1.87–613.42, low certainty) or a shockable initial cardiac rhythm (odds ratio 7.29, 5.09–10.44, moderate certainty), based on pooled unadjusted analyses. Importantly, mechanism of injury was not associated with either ROSC (odds ratio 0.97, 0.51–1.85, very low certainty) or survival (odds ratio 1.40, 0.79–2.48, very low certainty). Conclusion: This review provides very low to moderate certainty evidence that pre- and intra-arrest prognostic factors following penetrating or blunt traumatic OHCA predict ROSC and survival. This evidence is primarily based on unadjusted data. Further well-designed studies with larger cohorts are warranted to test the adjusted prognostic ability of pre- and intra-arrest factors and guide therapeutic decision-making.
KW - Out-of-hospital
KW - Prehospital
KW - Trauma surgery
KW - Traumatic Arrest
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U2 - 10.1016/j.resuscitation.2020.05.052
DO - 10.1016/j.resuscitation.2020.05.052
M3 - Review article
C2 - 32531405
AN - SCOPUS:85086847695
SN - 0300-9572
VL - 153
SP - 119
EP - 135
JO - Resuscitation
JF - Resuscitation
ER -